En bloc explant with lift 1 year ago gone wrong, why are my breasts deformed? (Photos)

The pectoralis muscle can't be repaired after dual plane or split technices, that's a legend, a myth, unfeasible no matter what you read or are told, the muscle shortens and can't be reattached, however this is not the cause of your deformity, I'll be on spot and brief:
-the surgeon failed to release the lower edge of the pectoralis muscle from the breast skin, that's why... you didn't tell us but I know well this problem is affecting you... you have animation deformity, when you contract the pectoralis you develop an awful and awkward deformity; solution: releasing the muscle and splitting it from the skin, easy as it sounds, unbelievable this was not done
-the breat lift pattern, a short inverted T or Wise patter, was unproperly planned and wrongly located, that's why your breasts look odd and square; solution: breast lift pattern revision, note: not another breast life, just a re-design of the pattern.

Your case is not a difficult one, but be sure you are not suggested artificial mesh, fat transfer, new implants, etc, it is cold and dangerous outside there, be wary and cautious, just straightworward technical proposals. No, your skin is not over streched, this is not the cause.

Giving428826: I am sorry to hear about your struggle following your explant procedure. Unfortunately, with multiple pairs of implants, especially ones as large as the ones you had, the breast and chest wall tissue can get deformed. I think in your case, it might be possible to revise your breast lift to remove a bit more skin. Apart from that, the next move that could help would be natural fat transfer.

Enbloc explant can be very destructive to the breast tissue. If you have limited natural breast gland and fat, the skin envelope has no foundation and can result in the appearance you present. This is a difficult problem, and if looking to improve will likely require getting volume back...ie implants. If you have fat to harvest fat grafting may also be a part of the plan. You need to find a surgeon with experience in breast reconstruction, not simple augmentation.

Your 600cc breast implants stretched and thinned your natural breast tissue, fat, and skin. When reconstruction (breast lift and/or fat grafting) is not performed at the time of explant, then the tissue can only fall the way it falls. Your surgeon could only anticipate the outcome -- only after removal do we know exactly how it will look.
Now that you have waited a year, you can decide if you want reconstruction. My recommendation would be fat grafting (to add volume, fill the deflated tissues, and improve the creases) and scar revisions (to reconstruct your inframammary fold).

Hi This is Dr Özge Ergün
Thank you for this detailed surgical history.
Your analysis is precisely aligned with current challenges in reconstructive mastopexy and complex soft tissue reconstruction."
"Following the requisite phase of tissue expansion—whether for breast mound reconstruction or soft tissue deficit repair—the resulting dermal envelope, or neocutaneous flap, often demonstrates residual dermal laxity and inadequate dermal-subcutaneous unit integrity, which is not fully addressed by subsequent skin-sparing excision."
"This results in the clinically challenging sequelae of poor tissue compliance, pleating or redundancy of the skin, and crucially, non-uniform peri-implant capsular contraction that compromises the final aesthetic contour."
Strategic Recommendation: Biomechanical Augmentation
"Given the need for further volume and surface area correction, we must initiate a subsequent period of re-expansion (or revision explantation/reimplantation). However, to mitigate the risk of adverse capsular dynamics and poor dermal quality, a biomechanical augmentation is indicated."
"I propose a combined strategy: utilizing the implant for its mechanical expansive force, but integrating it with artificial tissue regeneration through techniques such as:"
1. Acellular Dermal Matrix (ADM) Placement: To provide a robust scaffold, ensuring inferior pole stability and promoting a more organized, uniform capsular deposition around the implant, thus stabilizing the pocket and improving the soft tissue-implant interface.
2. Autologous Fat Grafting (ADSC-Enriched): To deliver Adipose-Derived Stem Cells (ADSCs), which biologically enhance the vascularity and thickness of the overlying skin. This bio-enhancement improves the skin's quality, elasticity, and capacity for predictable remodeling—a critical factor for achieving superior, long-term aesthetic outcomes and contour fidelity."
"This integrated approach shifts the paradigm from purely mechanical stretching to a biologically optimized reconstruction."

Hello, and thank you for sharing your experience and photos.
After an en bloc explant combined with a mastopexy (breast lift), it’s not uncommon to see contour irregularities, loss of upper pole fullness, and shape asymmetry—especially in patients who previously had large implants placed under the muscle for many years.
When implants are removed, the breast tissue and skin envelope often do not have enough elasticity to redrape smoothly over the chest. In addition, if the pectoralis muscle was altered or detached during the earlier surgeries (as your surgeon suspected), that can also contribute to chest wall irregularity and animation deformity.
At one year post-op, the healing process is mostly complete, so if your breasts still appear deformed, there may be residual skin laxity, loss of internal support (parenchymal structure), or a need for muscle repositioning that was not done at the time of explant.
A revision procedure can often improve the shape and projection by addressing these factors. Options might include:
Auto-augmentation mastopexy using your own tissue for upper pole volume
Fat grafting to restore contour and softness
Muscle repair or internal bra techniques to re-support the breast
A detailed in-person evaluation with an experienced revision surgeon is essential to plan the best strategy for your anatomy and goals.
Warm regards,Op. Dr. Yücel Sarıaltın, MDPlastic, Reconstructive & Aesthetic SurgeonIstanbul, Turkey

Based of your photos - over the years of having implants for so long and going larger as you aged - your breast tissue got thinner and more of your breast became mostly implant and very little breast tissue, muscle and stretched out skin. Now when you remove such large volumes and not replace the volume that has been removed, you get the collapsed look where your breast just fall in and likely that is how you will be unless volume is restored at least some with another lift likely needed. Revisit with your surgeon and see what the next step is or seek out second or third opinions and see which one you match best with. But you will need another procedure to restore some volume / re-lift in order to fix some of those defects you have. Hope this helps.

I'm really sorry you're feeling this way about your outcome, it's absolutely valid to want answers and to feel frustrated after such a long journey. Long-Term Implant Effects on Tissue & Muscle could be Tissue Thinning & Stretching (20 years of implants), Implants, especially larger ones like 600cc, stretch the skin and thin out the breast tissue over time. Once the implants are removed, that skin and tissue often can’t “bounce back”, especially after menopause or near it (which impacts skin elasticity). Pocket Expansion & Asymmetry, over time, the pocket where the implant sat (especially with dual plane placement) can enlarge or migrate, creating an odd shape or “emptiness” after explant. This can cause concavity, indentations, or a “snoopy nose” deformity (where the breast tissue droops off the lower pole). Muscle Deformation or Scarring, even if your pectoral muscle wasn’t cut, it may have been stretched or distorted over the years. If muscle was partially detached during the original augmentation (as sometimes done with submuscular placement), that change might not self-correct even without visible damage now. The fact your surgeon was concerned about the tight cleavage suggests suspicion of pectoral muscle damage or alteration. Even if he didn’t see a full tear or cut, the muscle could still have been thinned, stretched, or scarred, altering breast shape. If you had animation deformity before explant (breasts moving when flexing chest muscles), that’s a sign the muscle was heavily involved and potentially compromised.

Your results are related to how your expanded skin envelope scarred back down to your chest wall. Unfortunately sometimes these outcomes are unavoidable after someone that has had large breast implants in place for long periods of time. Aggressive massage additional time may help improve your outcome however an acceptable aesthetic outcome may only be achievable with a replacement of your implants. Other options would include fat grafting, however this may take multiple rounds to achieve the desired outcome. An in person consultation with a certified plastic surgeon can give you a personalized treatment plan.

Thanks for your question! I have found that explant with en bloc can create skin deformities and can compromise breast tissue. You may benefit from some fat grafting to help improve the appearance. I would seek out a second or third opinion. Good luck!